NPI | 1285330084 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: ID PA-2739) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PA-1157) |
363A00000X Physician Assistant (Licence: ID PA-2739) | |
363AS0400X Physician Assistant, Surgical | |
Enumeration Date | 2023-02-02 |
Last Update Date | 2024-09-10 |